Cancer Registries in the Middle East & North Africa Joe B. Harford, Ph.D. Center for Global Health National Cancer Institute harfordj@nih.gov
Summary of Presentation ! Cancer registry is a means and NOT an end with the ultimate goal of cancer registry being to enhance cancer control & cancer research ! The Middle East Cancer Consortium (MECC) is an example of regional cooperation in cancer registry ! NCI has invested in MECC since 1996 especially in the areas of creation & adoption of standards and training ! Cancer registry in the Middle East and North Africa (MENA) is woefully inadequate but progress is being made ! MECC has contributed to the expansion of cancer registry in Turkey, and a MECC registry has been selected by IARC as the site for a regional hub within its GICR initiative ! MECC’s cancer registry activities have also led to a major initiative in palliative care in the region
Activity is NOT Enough “Never mistake activity with accomplishment.” Basketball Coaching Legend John Wooden
Cancer Registries & Cancer Control “ The cancer registry is essential to cancer control, and cancer control is essential to (the survival of) the cancer registry.” Armstrong, B.K. Cancer Causes & Control 3:569 (1992)
Bruce Armstrong’s 6 X 9 Grid on the Role of Cancer Registries in Cancer Control (IACR, 1992) Primary Prevention Basic Research Basic Research Development of Intervention Development of Intervention Evaluation of Intervention Evaluation of Intervention Palliative Screening Care Situation Analysis Situation Analysis Awareness Raising Awareness Raising Cancer Program Planning Program Planning Control Program Implementation Program Implementation Program Monitoring Program Monitoring Future Planning Future Planning Survivors’ Early Issues Diagnosis Role of Cancer Registry: Treatment Central (34/54) Support (9/54) Cancer Causes & Control 3:569
5 Steps of Cancer Control Planning “Failing to plan is planning to fail” ! Assess needs and capacity ! Decide approach to planning ! Develop the plan ! Implement the plan ! Evaluate the plan = Where cancer registries particularly assist
The Middle East Peace Process Formed the Backdrop for MECC in 1996 MECC Members: ! Cyprus ! Egypt ! Israel ! Jordan ! Palestinian Authority ! Turkey
MECC-Affiliated Cancer Registries Began Cooperation in 1996 Amman Bethlehem Gaza City Nicosia Tant Jerusalem Izmi a r
Cancer Registries of the MENA Region MECC flagship registries submitting data for Ci5 Vol. X: Cyprus, Egypt (Gharbiah), Israel, Jordan, Turkey (Izmir) MECC flagship registries not submitting data for Ci5 Vol. X: West Bank, Gaza “Second Generation” registries of MECC members submitting data for Ci5 Vol. X Other MENA registries submitting data for Ci5 Vol. X
MECC Cancer Registries Engage in Regional Cooperation With Common Standards 87 pages 78 pages www.mecc.cancer.gov
MECC Monograph Chapters Overview and Summary Data Esophageal Cancer Stomach Cancer Colorectal Cancer Liver and Intrahepatic Bile Duct Cancer Lung Cancer Laryngeal Cancer Breast Cancer Cervix and Corpus Uterine Cancer Ovarian Cancer Urinary Bladder Cancer Each chapter compares cancer rates Brain and Other Central Nervous System Cancer among populations and poses relevant research questions. Thyroid Cancer Lymphoma and Leukemia
Breast Cancer Incidence Rates Although the average SEER age for breast cancer is younger in Arab Israel - Jews populations, breast cancer in women under 35 is very rare in all populations and not Cyprus higher in Arab women. Egypt Israel - Arabs Jordan
Chance of Breast Cancer in a Given Decade of Life: U.S.-White vs. Egypt Egypt (Tanta) U.S.-White 5 4.85 Most recommendations in U.S. start mammographic Pe 4.11 screening at age 50yr 4 rce nt 3 2.87 2 1.56 1.31 1.11 1.08 1 0.86 0.43 0.41 0 30-39 40-49 50-59 60-69 70-79 Age Group 3 1 2 1 4 5 0 4 Egypt (Tanta) 2 U.S.-White 3 5 0 40-49 70-79 60-69 0.43 0.41 1.56 1.08 2.87 1.31 4.11 1.11 4.85 0.86 0.43 0.41 1.56 1.08 2.87 50-59 30-39 70-79 60-69 50-59 40-49 30-39 0.86 4.85 1.11 4.11 1.31 Source: Harford JB, Lancet Oncol. 2011 Mar;12(3):306- Data from NCI SEER & Gharbiah Cancer Registry 12.
Bladder Cancer in Egypt ! Bladder cancer associated with infection by Schistosoma haematobium % tends to be squamous cell 80 carcinoma ! Bladder cancer associated 60 with tobacco use tends to Transitional be transitional cell Squamous 40 carcinoma 20 0 1980 2005 0 Transitional 80 1980 2005 60 1980 2005 40 20 0 80 60 40 20 Squamous
Cancer Registries of Turkey Site of the IARC regional hub within its GICR initiative In Ci5 Vol. IX MECC “Flagship” registry at Izmir submitting data for Ci5 Vol. X “Second Generation” registries of Turkey submitting data for Ci5 Vol. X
The 3 Most Significant Features of Cancer in MENA 80 % 1. Late Diagnosis 60 Breast 2. Late Diagnosis Cancer Unknown 3. Late Diagnosis Late 40 Early 20 0 U.S. Egypt 60 40 80 Early Late Unknown 40 20 0 80 60 20 0 Egypt U.S. Egypt U.S. MECC Monograph on Palliative Care “Where can I go in this desert to find out about how to prevent cancer or detect it early enough so that it won’t kill me?”
MECC Cancer Registry Project Executive Committee Michael Hoda Joe Harford Silbermann Anton-Culver NCI Liaison Kevin Ward & John Young MECC UC Irvine, Emory University, Executive Registry Responsible for Registry Training Director Steering Committee Chair “Registries require sustained commitments and trained personnel” Report commissioned by OIA/NCI & produced in 2007 with support of NCI and ACS
Today’s Presentation Was Intended to Highlight the “Tip of the Iceberg” For more details on any aspect of the presentation, contact: Joe B. Harford, PhD NCI Center for Global Health harfordj@nih.gov
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